The Effect of Financial Incentives on Utilization of Low-cost Providers

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. Identifier: NCT02249156
Recruitment Status : Active, not recruiting
First Posted : September 25, 2014
Last Update Posted : March 7, 2017
University of Southern California
University of California, Berkeley
Information provided by (Responsible Party):
Ateev Mehrotra, Harvard Medical School

Brief Summary:
Several employers in the US have introduced a program where their employees receive a financial incentive to receive lower cost care. Under this "Rewards" program, patients are free to choose providers but if they visit a pre-determined low-cost laboratory or radiology facility (called a "rewards provider"), they receive a financial incentive. The financial incentive is typically in the form of a Health Savings Account (HSA) contribution. The dollar amount varies by employer. This study will use medical claims data to examine if this program leads to an increase in the volume of services performed by low-cost providers and decreased health care spending.

Condition or disease Intervention/treatment
Receipt of Radiology Studies Receipt of Laboratory Tests Behavioral: Financial incentive for choosing a lower-cost provider

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Study Type : Observational
Estimated Enrollment : 884000 participants
Observational Model: Cohort
Time Perspective: Retrospective
Official Title: The Effect of Financial Incentives on Utilization of Low-cost Providers
Study Start Date : August 2014
Estimated Primary Completion Date : December 2017
Estimated Study Completion Date : March 2018

Group/Cohort Intervention/treatment
Financial incentive group
Employees of employers who have introduced the Rewards program. Currently there are two employers who have introduced the Rewards program, but there might be others that introduce it in the coming months. All intervention (and control) employers are customers of Castlight and use their price transparency product.
Behavioral: Financial incentive for choosing a lower-cost provider
Employees of the intervention group receive money (either as a payment to their health savings account or directly as a check) if they obtain a radiology test or laboratory test from what a low-cost or rewards provider. The amount of money per test varies by the employer and type of test. A provider is identified as low-cost or rewards if their costs are in the lowest 10-20% among all providers in the community. Again there is a range because the relative cutoff has varied across the employers that have implemented this program.

Control population
Large employers who have not introduced the Rewards program, but work with Castlight and use their transparency product. It will be ideal if the control population looks similar to the intervention population in key characteristics - age, level of illness, industry of the employer (for example, manufacturing), pre-intervention spending, and geographic distribution. If possible, across a pool of potential control employers, we will identify control employers that look the most similar across these characteristics in the pre-intervention period. Another possible strategy we might use is to weight the individuals in the control population in our analyses by how similar they appear to those in the intervention population.

Primary Outcome Measures :
  1. Service volume [ Time Frame: In 12 months after intervention initiated ]
    Service volume for each provider-employer before and after the introduction of the rewards programs. We will estimate models with several potential measures of volume including the number of services performed, the number of unique patients seen by the provider, and the fraction of all services received by the employees.

Secondary Outcome Measures :
  1. Total spending [ Time Frame: In 12 months after intervention initiated ]
    Total spending on laboratory and imaging services

  2. Utilization of laboratory and imaging services [ Time Frame: In 12 months after intervention initiated ]

Information from the National Library of Medicine

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Ages Eligible for Study:   1 Year to 99 Years   (Child, Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Sampling Method:   Non-Probability Sample
Study Population
The study population is composed of employees of both the intervention and control employers. We will use medical health plan claims from 2012 to 2014 for laboratory and imaging services across the study population. Health plan claims data will be provided by Castlight Health. The approximate number of providers of laboratory and radiology services who will provide care to this population will be 475,000.

Inclusion Criteria:

- Employee or dependent of an intervention or control employer

Exclusion criteria:

- Not continuously enrolled in health plan and therefore some claims may be missing

Responsible Party: Ateev Mehrotra, Associate Professor, Harvard Medical School Identifier: NCT02249156     History of Changes
Other Study ID Numbers: AG043850-01
First Posted: September 25, 2014    Key Record Dates
Last Update Posted: March 7, 2017
Last Verified: March 2017

Keywords provided by Ateev Mehrotra, Harvard Medical School:
Health economics
Financial incentives
Health care spending